But even when you’re on top, you have your lows. Emotional pain can lead to physical pain.

In the latest issue of Self Magazine, the 19-year-old opened up about something that cuts deep, and that’s literally cutting yourself.

“There were times I felt so anxious, almost like I was crawling out of my skin — that if I didn’t do something physical to match the way I felt inside, I would explode,” she explained about her issues prior to entering a treatment center in late 2010. “I cut myself to take my mind off that. I just didn’t care what happened. I had no fear.”

Aside from cutting, Demi has had bouts with an eating disorder and a bipolar disorder. In fact, in her documentary Stay Strong, the pop star divulged how all of those issues are still an everyday struggle, but it’s something she works at on a daily basis.